I am growing a moustache. This is not the kind of thing you usually need to broadcast but I am growing it as part of Movember because I believe these kinds of mission-specific campaigns are crucial to finding news ways to fund health-related services.
To be honest, I have always hated campaigns to raise money for health care. I live in the UK and part of our social contract is that we pay taxes so that we can get health care for ‘free’, a dumb way of saying we don’t pay for it when we need it as we’ve already paid. But these days I increasingly believe we need to find alternative ways to approach health and care, including funding it, and that the existing health care system is not best-placed to lead this search.
It’s well documented that existing systems struggle to do anything other than incremental change and yet what we need in health and care is radical reinvention. Nothing illustrates this more than the increasingly accepted fact that health care is massively wasteful and yet seems unable to do anything about it. In the US, the Institute of Medicine has shown that the system is 30% waste, largely due to over-treatment and the use of questionable technology. In the UK, the Academy of Medical Royal Colleges suggests it’s 20% (link downloads a PDF).
Do we really believe the US and UK health care systems will lead the search for new approaches to health and care that might reduce their revenues by US$800bn and £20bn, respectively? I don’t.
To illustrate how unlikely this is, consider this recent Perspective in NEJM illustrating how thyroid cancer has become rabidly over-diagnosed in the Republic of Korea as a result of a national cancer screening programme. There are two amazing parts to this story: first, thyroid cancer screening was not even part of the programme, it was added by hospitals and doctors’ offices because it was easy to do; and second, the majority of new cancers that were identified were not life threatening. All in all, this seems to be a case of hospitals and doctors’ offices using their positions to advocate over-treatment in order to line their pockets.
Note that I’m not saying that individual doctors are specifically looking to line their pockets, more that the system they operate in encourages such behaviour. When clinicians are brave enough to work outside the system, they often say it like it is – and to great effect. My two favourite examples this week – and there are good examples every week – are doctors Benjamin Davies and Rupert Whitaker. Davies wrote a brilliant piece about inappropriate claims in direct-to-consumer advertising in the New York Times and the New Yorker; I especially loved his use (and perhaps coining) of the term ‘hopeium’ – pushing false hope to sick, and hence vulnerable, people. Whitaker wrote an insightful analysis of how when we limit health to physician-centred approaches we limit what we can truly achieve.
Radical reinvention of health and care will only happen from outside the existing system and will only be possible if there are resources to experiment with. That’s where Movember comes in. It was started in 2003 by two blokes in Melbourne, Australia, who joked about bringing the ‘tache back into fashion. They didn’t raise money that year but they got 28 others to join them. The next year 480 got involved and they raised over £21,000. In 2013, the figure was £77m. That’s a half-decent wodge of cash with which to search for future approaches to men’s health and care.
Despite my enthusiasm for Movember (and my willingness to look like a total idiot), I do think their current approaches are overly bio-medical, perhaps inevitably so given their Global Scientific Committee is made up of doctors and biomedical scientists. However, what Movember is illustrating is how consumers can be corralled around a specific mission to raise money. The fact that this money is independent of the current health care system is a big deal and needs to be capitalised upon – perhaps more than it already is so far.
It’s important to note that there are organisations within the current health care system trying to change their approach, principally by focussing on population health as well as health care. Once such organisation is Nemours Children’s Health System in Delaware, USA. They recently used a grant to try to reduce hospital admissions of children with asthma. They saw some success but fewer admissions meant less revenue. As the CEO, David Bailey, said:
“As a business executive, it puts me in a quandary. I’m going to have to fill in the [lost revenue] from someplace. Do I take it from bone marrow transplants? Behavioral health? We’re going to have to work very hard to move reimbursement to allow for these new approaches, and still keep our doors open.”
Bailey's honesty is an excellent example of the kind of leadership needed within the failing system that is health care. It also illustrates precisely why money raised through endeavours like Movember cannot be trapped in what health care is today; it has to be used to find what health care can be tomorrow.
To help Movember, to aid the search for ways to approach men’s health and care, and to make it easier for me to continue to look like a total idiot until the end of the month, please sponsor me.